Court overturns Hopkins malpractice case

Andrea K. Walker, The Baltimore Sun

The Maryland Court of Special Appeals overturned a multimillion-dollar judgment against Johns Hopkins Hospital in a case that accused its doctors of causing severe and irreversible brain damage to a baby born at the hospital.

The judges ordered the case sent back to a lower court for retrial. They ruled that Hopkins should have been allowed to give more testimony about the role a midwife might have played in the baby's injuries.

Attorneys for the baby's family said Wednesday that they will appeal the decision to the Court of Appeals, the state's highest court.

Hopkins spokeswoman Kim Hoppe would not discuss the verdict because the litigation is still pending, but said the institution was "pleased" with the recent decision.

The case stems from February 2011, when Rebecca Fielding and Enso Martinez sued Hopkins, alleging that their son, Enzo, was deprived of oxygen to the brain the previous March as the mother waited for a cesarean section at the hospital. He was diagnosed after birth with hypoxic ischemic encephalopathy, a disease that causes permanent and severe cognitive delays.

The case gained attention around the state for its $55 million judgment, one of the largest malpractice awards in Maryland history. A trial court later reduced that judgment to $28.3 million, in part because of a state cap on damages.

The latest ruling breaks ground once again because it is the first time a state court has addressed whether the negligence of a person not directly involved in a case can be used at trial. The appeals court cited cases from several other states in reaching its decision.

Baltimore malpractice attorney Andrew G. Slutkin, who was not involved in the case, said the Court of Special Appeals ruling could create a precedent in Maryland.

"This is something that Maryland courts have never decided," he said. "It will be interesting to see what happens at the Court of Appeals. The final chapter of this story hasn't been written."

Hopkins has contended that the baby's injuries were caused by procedures performed by midwife Evelyn Muhlhan, who tried to deliver the baby before sending the mother to Hopkins by ambulance.

Muhlhan's license was suspended by the Maryland Board of Nursing because of her alleged actions during the delivery of Enzo as well as four other home deliveries over three years. Online records show that her license remains suspended.

A man who answered the phone at Muhlhan's home said the midwife would not make a comment regarding the case.

Hopkins argued in its appeal to the Court of Special Appeals that it was only allowed to give limited evidence about Muhlhan's work during the jury trial.

"In the judge's eyes, she was not a defendant," Slutkin said. "Whether she was negligent was not before the jury."

The hospital's lawyers could tell jurors about procedures Muhlhan performed when trying to deliver young Enzo, but couldn't present expert testimony or other evidence to show that she was negligent.

Jurors heard that she performed fundal pressure, or pushing on the upper part of the uterus to encourage delivery, a procedure that Hopkins doctors said is no longer standard practice. A Hopkins doctor also told jurors that Muhlhan gave Fielding injections of the labor-inducing drug Pitocin, which prevented relaxation between contractions, making it harder for the baby to get sufficient oxygen. Muhlhan also administered the drug through intramuscular shots rather than slowly through an intravenous drip, which is standard practice.

Gary Wais, a lawyer for the family, said what Hopkins was able to present should have been enough for a jury to make a judgment.

"We believe Hopkins was absolutely able to get a fair trial and argue that the sole cause of Enzo's deficiencies was because of what was done by the midwife before the mom got to the hospital," Wais said. "The jury heard everything except that the conduct was negligent."

In siding with Hopkins, the court said the family's lawyers were able to say how Muhlhan's treatment was appropriate, but Hopkins couldn't say how it was negligent.

"The only evidence of negligence before the jury was the negligence of the hospital," the court wrote in its opinion. "Consequently, the only evidence of negligence before the jury was the alleged negligence of the hospital."

Wais argued in court that Hopkins doctors waited too long to perform a C-section after Fielding arrived at the hospital. The couple's lawyers also argued that doctors ignored signs of fetal distress and should have done an emergency C-section.

Hopkins doctors countered that they needed to do blood tests to determine if Fielding could receive an epidural painkiller before delivery. They also gave her penicillin to prevent a bacterial infection from spreading to the baby and performed other pre-delivery procedures. A fetal heart monitor showed that the baby was not in distress, the doctors also argued.

Enzo was born in poor condition and now suffers from cerebral palsy, retardation and other disorders, according to court records.

Supporters of home birth said the Hopkins case shows how midwives are often treated unfairly. Jeremy Galvan, a Hagerstown paramedic and president of Maryland Families for Safe Birth, said the majority of home births happen with no complications. Those that end up in the hospital are usually for nonemergency reasons.

"I think what this highlights is that even at the best hospital we have in the state, the tension between midwives and obstetricians is extremely high," he said. "Sometimes emergencies have to happen and midwives get blamed."